The ManicaPost
Catherine Murombedzi Health Correspondent —
Approaching treatment and care after testing HIV positive is an issue that needs to be dealt with in detail. Many people say with ARVs now on the market what is the fuss about. There are a lot of factors to be considered.
First being acceptance. Has the person accepted the new status and understand what it entails? Has information on what is happening in the body been fully given to understand why one now needs life long medication? Has access to medication been taken into consideration?
By access there are those who afford to buy on their own and then the others who need assistance with medication and even assistance with cash for some of the tests. One needs to have the liver tested and this liver test function is costly to most people. It costs around $30 and most can not afford it. With the new guidelines of test and treat a CD4 count can be skipped so can the viral load at the beginning.
We once looked at the advantages and disadvantages of test and treat. In Zimbabwe we have 1,6 million people living with HIV. Of these 870 000 are on treatment. This shows a huge number of people still in need of treatment. This brings us back to test and treat in the local context.
Do we apply a blanket measure applicable to developed world and countries that have no one on the waiting list? Dr Iris Shiripinda of the faculty of health sciences at Africa University said Zimbabwe has to take a local approach suitable to her needs.
“The World Health Organisation gives guidelines on treatment issues but as a country we have to deliberate on applicability. Putting one on life long treatment is a serious health concern which must be handled with the importance it deserves, “ said Dr Shiripinda.
That brings to the fore accessibility. Access takes into account the availability of medication and care together with support. Is the health care centre within reach? Does one need to get onto a bus or it is walking distance? All this needs to be looked at. Treatment literacy is an issue that we even find in people who have been on anti retro viral therapy (ART) even for a couple of years lacking.
Did the nurse or doctor fully equip the patient before commencing ARVs. A few months or years after commencing ART and feel well they have a fallacy that they are well for life. They then default and within months fall seriously ill.
Instead of going to the old centre they change clinics and report to a new centre as a first time patient. This is where the literacy gap is yawning. Was the patient equipped to understand what takes place when on ARVs and effect when one stops? ARVs suppress the viral load thereby restoring the immune system.
ARVs are not a cure but suppress the viral load. A patient needs that information otherwise they default on the assumption that they are cured. At the moment ARVs just suppress the viral load. An aspect that needs not to be ignored is acceptance. As long as one has not accepted being HIV positive as a diagnosis then there is no hurry to place them on medication because they will default.
Defaulters have severe risks as compared to the first time before they were on medication.
Care and support is an integral part of health. Is there support emotional not just medically?
Is the person able to come back to have further questions answered if they arise. There are a few health personnel who do not care even if one does not understand.
It is not the whole staff establishment so if one encounters challenges with rude staff they can see a senior staffer who can help at the same institution.Support is also needed from home. However, we find some people not even able to disclose to family or spouse for fear of reprisals.
Now someone taking ARVs in hiding is a candidate for defaults. Everyone on life long medication be it for high blood pressure or diabetes mellitus needs a medic buddy who reminds them to take medication. The same applies to positive living. So before commencing one on ARVs the above need interrogation in depth.
Be well, accept your new status if you have tested HIV positive. There is life in acceptance.
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